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首页> 外文期刊>Nature clinical practice. Rheumatology >Therapy Insight: fibromyalgia--a different type of pain needing a different type of treatment.
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Therapy Insight: fibromyalgia--a different type of pain needing a different type of treatment.

机译：Therapy Insight：纤维肌痛-一种不同类型的疼痛，需要不同类型的治疗。

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In the past decade, we have made tremendous progress in our understanding of fibromyalgia, which is now recognized as one of many 'central' pain syndromes that are common in the general population. Specific genes that might confer an increased risk of developing fibromyalgia syndrome are beginning to be identified and the environment (in this case exposure to stressors) might also have a significant effect on triggering the expression of symptoms. After developing the syndrome, the hallmark aberration noted in individuals with fibromyalgia is augmented central pain processing. Insights from research suggest that fibromyalgia and related syndromes require a multimodal management program that is different from the standard used to treat peripheral pain (i.e. acute or inflammatory pain). Instead of the nonsteroidal anti-inflammatory drugs and opioids commonly used in the treatment of peripheral pain, the recommended drugs for central pain conditions are neuroactive compounds that downregulate sensory processing. The most efficacious compounds that are currently available include the tricyclic drugs and mixed reuptake inhibitors that simultaneously increase serotonin and norepinephrine concentrations in the central nervous system. Other compounds that increase levels of single monoamines (serotonin, norepinephrine or dopamine), and anticonvulsants also show efficacy in this condition. In addition to these pharmacologic therapies, which are useful in improving symptoms, nonpharmacologic therapies such as exercise and cognitive behavioral therapy are useful treatments for restoring function to an individual with fibromyalgia.
机译：在过去的十年中，我们在理解纤维肌痛方面取得了巨大的进步，而纤维肌痛现已被认为是普通人群中许多常见的“中央”疼痛综合症之一。已经开始鉴定可能增加患纤维肌痛综合征风险的特定基因，环境（在这种情况下，暴露于应激源下）也可能对触发症状的表达产生重大影响。患上该综合征后，纤维肌痛患者出现的标志性异常会加剧中枢性疼痛。研究表明，纤维肌痛和相关综合征需要一种多模式管理程序，该程序与用于治疗周围性疼痛（即急性或炎性疼痛）的标准不同。代替通常用于治疗周围性疼痛的非甾体类抗炎药和阿片类药物，推荐用于中枢性疼痛的药物是下调感觉过程的神经活性化合物。当前可用的最有效的化合物包括三环药物和混合再摄取抑制剂，它们同时增加中枢神经系统中5-羟色胺和去甲肾上腺素的浓度。其他增加单一单胺（5-羟色胺，去甲肾上腺素或多巴胺）和抗惊厥药水平的化合物在这种情况下也显示出功效。除了这些可用于改善症状的药物疗法之外，非药物疗法，例如运动和认知行为疗法，对于恢复患有纤维肌痛的个体的功能也是有用的疗法。

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